Treatment is determined by age, upper vs lower UTI and clinical condition.
Infants less than 3 months
NICE recommends that children under 3 months should be referred to paediatrics for IV antibiotics. Initial antibiotic therapy for infants under 3 months with fever is a third generation cephalosporin together with an antibiotic with listeria coverage (e.g. ceftriaxone and amoxicillin) [4, 6].
Infants and children older than 3 months
With bacteuria (demonstrated by a positive leukocytres/nitrites on dipstick), and either;
• Fever >38°C or
• Loin pain/tenderness
= Treat as pyelonephritis/upper UTI [1]
With bacteriuria(demonstrated by a positive leukocytres/nitrites on dipstick) with;
• No systemic symptoms or signs
= Treat as cystitis/lower UTI [1]
Learning Point:
Do not use CRP to differentiate between pyelonephritis and cystitis
Antibiotic Choice
Consider allergies, recent antibiotic use, previous urine MC&S results and local microbiology guidance when prescribing.
Pyelonephritis if; [6]
• Sepsis/severely unwell
• Vomiting/unable to take oral medications
IV antibiotics e.g. Cefuroxime, ceftriaxone, co-amoxiclav, gentamicin
Pyelonephritis – otherwise; [6]
Oral antibiotic for 7-10 days e.g. cefalexin, co-amoxiclav
Cystitis[7]
Oral antibiotic for 3 days e.g. trimethoprim, nitrofurantoin